Last week I wrote about the anticipated 23 percent cut in Medicare physician reimbursements. And I explained that this cut is the result of a Clinton-era formula for reimbursement — called the “sustainable growth rate” (SGR) — not the new health care reform law. And I also wrote about the way Republicans in Congress blocked all attempts at a remedy so they could go home to their constituents and blame the looming cuts on “Obamacare.”

N.C. Aizenman writes about this in the Washington Post — “Doctors say Medicare cuts force painful decision about elderly patients.” Physicians complain that they can’t afford to see Medicare patients, they say, because since 2000 their expenses have gone up 18 percent but reimbursement has gone up only 5 percent. And then there’s that 23 percent cut, which will go into effect December 1 if Congress can’t stop it.

Aizenman also writes in the WaPo article that the way physicians are reimbursed now tends to overpay specialists and underpay primary care physicians. This has been going on since before Barack Obama was elected.

What’s not mentioned anywhere in this news story is the Patient Protection and Affordable Care Act (PPACA), or this year’s health reform law. That’s because the PPACA really isn’t part of this situation. The only connection is that a provision in an early version of the bill that would have eliminated the SGR was cut out at the insistence of deficit-hawk conservatives.

In other words, the passage of the PPACA did not cause this problem, and what parts of the PPACA that might help rein in Medicare costs eventually haven’t gone into effect yet, again to placate the deficit hawks. Yet that didn’t stop The Usual Knees from jerking.

Remember folks, all that talk about Death Panels, reduction of doctors’ availability, etc. under Obamacare was just a series of Republican lies. … So now that we passed it, and we are beginning to see what is in it, how does it look? Do you think maybe we should have figure out what was in it, before we passed it?

Amusingly, the blogger quoted above urges his readers to “read the whole thing” when he, apparently, did not. Or else he can’t read.

Recall that these steep cuts to Medicare reimbursement rates are the way in which the Obama administration was able to claim that a) Obamacare cost less than a trillion dollars and b) it would bend the cost curve. In fact, the administration now has a stark choice between instituting the “doc fix” which would rescind the Medicare cuts or welcoming in the era of decreased access and rationing via long wait times. They don’t have long. The rate cuts to Medicare reimbursement are set to begin December 1st.

But the rate cuts were not dictated by the PPACA but by another law passed back in 1997. The original PPACA bill would have eliminated the cuts resulting from the 1997 SGR formula, but at conservatives’ insistence this provision was taken out. But when Democrats attempted, first, to repeal SGR in a separate bill, and then to pass the usual one-year “doc fix” to postpone the cuts another year, it was Republicans who blocked it.

And it’s too obvious that the reason Republicans wouldn’t stop the rate cuts is that they could be blamed on “Obamacare,” even though they aren’t the fault of “Obamacare.”

The cuts to Medicare in PPACA were mostly to Medicare Advantage, a popular program that unfortunately costs taxpayers more than regular Medicare. However, from what I can glean from this fact sheet from the Congressional Research Service, PPACA as passed does not directly address the basic physician reimbursement rates in regular Medicare that people are complaining about. Instead, it establishes a Medicare Payment Advisory Commission to report to Congress in March of every year recommending what adjustments might be needed to the rate. But we haven’t heard from the MedPAC yet, and I’m not sure if it’s even been appointed.

Beside trimming back Medicare Advantage, the other major cost-saving Medicare plan in PPACA is to “bundle” hospital payments — instead of reimbursing for every individual procedure, hospitals will be reimbursed for treating a person’s condition over a period of time — X amount for six months of diabetes treatment, for example. This should eliminate hospitals’ padding their profits with unnecessary procedures.

But if the 23 percent cut isn’t stopped, could cause massive disruption in seniors’ health care. Perhaps since the midterm elections are done, the GOP will relent and at least go along with a temporary “doc fix” and kick the can down the road another year. But I suspect it’s going to be awfully tempting for them to block the fix one more time, because it’s all too easy to persuade the peabrains who support them that it’s all Obama’s fault. And if it puts some of the older folks at risk, it’s all for the glorious Republican cause.

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While I would hope that a bipartisan fix might be in the works, you are probably correct in guessing that this situation is just too rich for the GOP to pass up. It feeds their own narrative, and the death panels will be here courtesy of the conservatives blocking any sort of solution.

They undermine. It’s what they do. Whether it’s women’s choice, or now SS, Medicare, Medicaid, etc., once something passes to help other people, despite their adament protestation, they then immediately begin to slice, slice, slice. And then blame everyone but themselves when things begin to fall apart.
For some reason, this reminds me of an old joke:
This guy’s car breaks down in front of farm. As he’s walking towards the house, he passes a pig pen where he see’s a lone pig. That pig has one good front leg, a stilt for the other front one, and he has no back legs, but gets around on some wheeled, scooter-like contraption.
The farmer comes out to see what he can do, the guys tells him his car broke down, the farmer helps him get it started, and as the guy’s about to leave, he asks the farmer, “What’s up with that pig?”
“What do you mean?” the farmer asks.
“Well, the stilts, the little scooter?”
“Oh, well that pig’s a hero! This one time, the house was on fire and we were all asleep, and the pig got out of his pen, and came and oinked and oinked until we woke up, and then he led us out through the fire and smoke.”
“Wow!” said the guy.
“Then another time, my little boy fell in a field where I was working, and I was about to run over him, when the pig came out of the blue and pulled him out just as I was about to run the thresher over him. And another time, he jumped in front of a car and saved my life!”
“Wow, that’s some pig you got there. So, he lost a few limbs saving you and your family?” the guy asked.
“What do you mean?” said the farmer.
“Well, the stilt, the little scooter
“Oh, no, he didn’t get hurt.”
“Well then, why the stilt and scooter?” asked the guy one last time.
“Well,” answered the farmer, “A great pig like that, you don’t eat it all at
once!”

And so, it is with SS and Medicare and Medicaid. One program’s been around for almost 75 years (3 generations – or 4?), and the other two for almost 50 years – all it took was a little tweaking to make them last that long. And that’s all it would take to make them last for generations and generations into the future. But no, the conservative Republican AND Democratic deficit-hawks would rather slice, slice, slice.
I guess, ‘with great programs like that, you don’t kill them all at once…’

I wanted to share this. I was driving today, and heard what I think summarizes the right-wing philosophy in one very short line.
I tuned to 770AM, NY City’s all reich-wing radio, just for shit’s and giggles, something I never do, but there was nothing on but games by bad NY teams on sports radio. And I heard the finish of Monica Crowley’s radio show (no, I didn’t know she had one either, but I’m not surprised because the people on the right like to spread their hatred and complete lack of talent in as many mediums as will take them) with Ted Nugent. Thankfully, I missed most of the idiocy, but I caught this gem. Monica was getting out of the interview, and she said something, jokingly, about Ted needing to get a little tougher, or something to that effect. This is when he spit out what, I’m sure is a line that brings down the house at conserve-a-tard gatherings:
“You know me,” he said,
“I trample the weak,
and I hurdle the dead!”
Well, there’s something to be proud of!
What a man! I harden at the thought of his manly voice hearkening these heartening and truthful words – NOT!!!
Oh, and then Monica went on to tell both of her listeners (well, 3, since I was there, too) to catch one of Ted’s concerts, that “Great Rock and Roll Legend!”
Uhm, Monica, Ted is not, I repeat NOT, a R&R legend. I am a R&R junkie! He is, at best, a ‘one-hit-wonder’ whose only song I can remember is the lamentable “Cat Scratch Fever.” Ted is no Hendrix or Clapton as a guitar player. I doubt if anyone would consider him as one of the top 1,000 R&R guitarist’s – and that’s in HIS prime in the mid-’70’s. And “Cat Scratch Fever” is no “Revolution,” “Satisfaction” or “Stairway to Heaven.” Hell, it’s down there with the song I should have mentioned in my comment the other day of worst songs of all times – “Muscrat Love.” Though, to give credit, Ted’s song was a bit edgier.

“I trample the weak and I hurdle the dead”? What the bleep does that even mean?

This tough guy posing thing is so pathetic. I just read that some guy was standing in the cash register line in a Boynton Beach Walmart, and somebody noticed he was armed, so they called the police. Turns out the guy had a .40-caliber Glock handgun with a 30-round magazine in a holster at his hip, and also two concealed knives and a “pepper grenade.” And I’m thinking, damn, it must get rough in Walmart these days.

The guy didn’t think he would be arrested because he had an Arizona permit for the gun, and the gun wasn’t concealed. He was just in the Walmart to buy some stuff, not to hold it up. But what does go on in your head if you think you can’t even go out bleeping Christmas shopping without being armed to the teeth?

“I trample the weak and I hurdle the dead”? What the bleep does that even mean?

Maha I am observing a pathology, for lack of a better word, on the forums from the lunatic fringe. From the hard-core libertarians to the neo-cons there is a two-pronged declaration of a philosophy that’s not conservatism. (Conservative political philosophy I usually disagree with, but I don’t detest – this is different, entirely. And it goes the other way – I have conservative friends – they are not out to destroy me – literally or figuratively.)

The first prong, which Ted described is contempt for the weak. The sickos who are WAY past conservative revel in the impending ‘failure’ of Medicare and Social Security. Not only do they not have answers – they don’t WANT to provide answers for the calamity that will befall seniors if there is no fix for the old system or proposal of a new system for seniors. Their hatred for any ‘New Deal’ program is so complete, they will make victims of 80 million seniors to drive a stake through the heart of FDR. (That’s why I say they are not ‘conservative’.)

The second prong is the glorification of the wealthy. This is pure Randian philosophy. To them it’s blashemous to suggest that the ‘government’ *(The word ‘government’ is the semantic equal to ‘sinners’ or ‘the damned’) the evil government can tell rich people what to do. Pay taxes? Noooo Observe rules. Noooooo. Wealth is its own justification – these people are princes among the commoners – that they are better than we are is proved by the degree of their wealth. They are the SOURCE of all good and must be revered and praised. (Don’t even try to bring up Ken Lay or Bernie Madoff – somehow they are the fault of government…)

No liberal that I know will say the government is always right or all rich people are corrupt and evil. The liberals that I know are all for the endless process of fixing what doesn’t work in government and the liberals I know view the excesses of Lay and Madoff as proof of the NEED for government intervention and supervision where corruption might/could harm the economic health of working folks. And most conservatives would agree with this last paragraph, I think. But there’s a different cat entirely out there, mixed in with conservatives, masquerading as one, who’s something else entirely – and dangerous.

Turns out the guy had a .40-caliber Glock handgun with a 30-round magazine in a holster at his hip, and also two concealed knives and a “pepper grenade.”…what does go on in your head if you think you can’t even go out bleeping Christmas shopping without being armed to the teeth

He probably just got through watching reruns of “24” (while listening to Ted Nugent music), and he sure as Hell wasn’t going out in public unless well-armed against the terrorist threat. And if not Al Qaeda, there are lots of other criminals out there (thanks to liberal judges, abortion, evolution, gay marriage and the global warming hoax). Really, you can’t be too careful. And if he shoots a bad guy, he’s gonna be a hero, like Agent Jack Bauer.

You’ve sure got to admire a tough guy like that. But of course, now Obama’s socialist thugs are persecuting him for exercising his 2nd Amendment rights.

“I trample the weak,
and I hurdle the dead!”
I think that was in “The Book of Matthew,” where Jesus explained his Gospel of killing the poor.
And I think the guy in the WalMart was following his Saviour’s teachings as explained in Luke. Where Jesus said, “You can give a man a sword, and he can only kill one person at a time, but if you teach a man to shoot an automatic, he can annihilate whole horde’s of Socialist government agents.” No one, of course, at the time knew what an automatic was, or a Socialist, so in the translation from the original Aramaic, they changed the whole parable into one involving some fish or something.
Sadly, Jesus was captured by the Romans unarmed, which is why the 2nd Amendment is soooooo important. If he was armed, there would have been a tsunami of Legionnaire blood, and Ol’ Pontius would have hightailed it back to Rome and Augustus himself would have come down to Jerusalem and surrendered, kneeling at Jesus’s feet.
So, the lesson here is that if you want the last PlayStaion on sale at WalMart before Christmas, be quick on the draw, and as Jesus said, “Don’t jerk the damned trigger MFer, squeeze it!”